polyethylene glycol hypersensitivity

It was recommended to carry on an emergency kit including an auto-injectable adrenaline shot. Negativity of BAT due to toxic effects was controlled by assaying a battery of decreasing concentrations of antigen. New evidence demonstrates more clearly that it is possible to develop severe immediate hypersensitivity to macrogols, of which the most familiar form to most physicians is polyethylene glycol (PEG) 3350. 2006;25 Suppl 2:121-38. doi: 10.1080/10915810600964642. Case report: To test doxylamine separately, we used Dormidina® 25 mg. Doxylamine is a histamine H1 receptor antagonist belonging to the ethanolamines group, such as diphenhydramine. We noticed that the preparation of doxylamine used in our prick test (Dormidina® 25 mg) contained PEG 8000. VJC was responsible for the patient and who established the diagnosis; carried out the allergological study, and prick tests; and drafted the manuscript. 2014;2(3):353–354. As in 2 of 37 patients of Wanande trial, we didn’t find specific IgE against ethylene oxide [2]. © 2021 BioMed Central Ltd unless otherwise stated. Jover Cerdá V, Rodríguez Pacheco R, Doménech Witek J, Marco de la Calle FM, de la Sen Fernández ML. Cases of immediate-type PEG hypersensitivity were reported with increasing frequency. The awareness regarding the allergenic potential of PEG should be raised and a proper product labelling is crucial to prevent PEG mediated hypersensitivity. Kleine-Tebbe J, Klimek L, Hamelmann E, Pfaar O, Taube C, Wagenmann M, Werfel T, Worm M. Allergol Select. Polyethylene glycols (PEGs) or macrogols are polyether compounds widely used in medical and household products. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Please enable it to take advantage of the complete set of features! A case of anaphylaxis caused by macrogol 3350 after injection of a corticosteroid. Toxicology. Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Sanchez Borges M, Senna G, Sheikh A, Tanno LK, Thong BY, Turner PJ, Worm M. World Allergy Organ J. I hope this is helpful. For this reason, we retested doxylamine prick test with Cariban® tablets, a drug used as antiemetic that contains doxylamine plus pyridoxine, but without any PEG. 2017;6(6):143–7. BAT resulted positive with PEG 4000 1% and PEG-derivatives (Fig. PEG is an active ingredient in bowel prep, and found in commonly utilized products. Six months later, 30 min after swallowing 30 ml of a cough syrup (GripaNait®: paracetamol, dextromethorphan, and doxylamine as active ingredients and several excipients, including macrogol 6000), she developed generalized pruritus, dyspnea, severe dizziness, seizures, loss of consciousness, and respiratory arrest, requiring urgent treatment with adrenaline, plasma expanders, and parenteral corticosteroids. Bruusgaard-Mouritsen MA, Johansen JD, Garvey LH. Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side effects. polyethylene-glycol conjugated (pegaspargase) and native E. coli asparaginase (L-ASP). 2021 Jan 4. doi: 10.1111/cea.13822. Polyethylene glycol (PEG)-coated nanopharmaceuticals can cause mild to severe hypersensitivity reactions (HSRs), which can occasionally be life threatening or even lethal. PubMed Google Scholar. However, our results give limited information on the safety of ethylene oxide for patients sensitized to PEG. It is important to remark that Coldistan® contains PEG as excipient. Alexander: I think if you've had a reaction to a vaccine or polyethylene glycol in the past, you probably will already know. Contact Dermat. 8600 Rockville Pike Concerns related to adverse effects:• Electrolyte imbalance: Prolonged, frequent, or excessive use may lead to electrolyte imbalance.• Hypersensitivity: Do not use if you are hypersensitive to polyethylene glycol. -, Bordere A, Stockman A, Boone B, Franki AS, Coppens MJ, Lapeere H, et al. Delayed type hypersensitivity to polyethylene glycol, widely used as a vehicle in cosmetics, suppositories and topical medicaments, is well known (Braun, 1969; Fisher, 1978). Hypersensitivity reaction is the primary adverse effect of both polyethylene-glycol conjugated (pegaspargase) and native E. coli asparaginase (L-ASP). Terms and Conditions, J Allergy Clin Immunol Pract. BACKGROUND: The most common immediate hypersensitivity to macrogols is associated with polyethylene glycol (PEG) 3350; however, the epidemiology, mechanisms, and cross-reactivity are poorly understood. SIDE EFFECTS:(polyethylene glycol (PEG)) Nausea, abdominal cramping, or gas may occur. Background: The most common immediate hypersensitivity to macrogols is associated with polyethylene glycol (PEG) 3350; however, the epidemiology, mechanisms, and … 1). This case report did not receive any other specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Severe allergic reactions after COVID-19 vaccination with the Pfizer/BioNTech vaccine in Great Britain and USA: Position statement of the German Allergy Societies: Medical Association of German Allergologists (AeDA), German Society for Allergology and Clinical Immunology (DGAKI) and Society for Pediatric Allergology and Environmental Medicine (GPA). Prick tests and basophil activation tests were performed to several pharmacological and cosmetic products, but only those containing PEGs and their derivatives were positive. volume 15, Article number: 9 (2019) The awareness regarding the allergenic potential of PEG should be raised and a proper product labelling is crucial to prevent PEG mediated hypersensitivity. Correspondence to Although this type of response to PEG 3350 is rare, it is helpful to know which symptoms you should look for and when you should call your doctor. OBJECTIVE: Our objective was to better understand the mechanism, cross-reactivity, and scope of … Contact Dermatitis. I think I am allergic to polyethylene glycol 3350--how will I know? By Cosby A. Part of Manage cookies/Do not sell my data we use in the preference centre. 2016;46(7):907–922. In the last 7 years she developed itchy maculopapular rashes in contact with some moisturizing skin creams containing PEG-75 and PEG-100. Immediate hypersensitivity reaction to polyethylene glycol 3350 Seung-Eun Lee, 1, 2 Ju-Young Kim, 1, 3, 4 Suh-Young Lee, 1, 4, 5 Su-Jeong Kim, 1, 6 and Hye-Ryun Kang 1, 3, 4 1 Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. Information on ingredients of a vaccine or medication (including PEG, a PEG derivative, or polysorbates) can be found in the package insert. Will Regulators Take Action? Although these polymers are usually safe, mild to life-threatening immediate-type hypersensitivity reactions have been reported. The most common immediate hypersensitivity to macrogols is associated with polyethylene glycol (PEG) 3350; however, the epidemiology, mechanisms, and cross-reactivity are poorly understood. FMMC and MLSF carried out the development, performance, and interpretation of the basophil activation test to PEGs and products containing PEGs. In November 2017, she experienced swelling of the gums and tongue after using a toothpaste for which she did not need treatment. Privacy 2021 Mar;62(3):326-332. doi: 10.1007/s00108-021-00959-5. Awareness about the allergenic potential of these polymers is minimal due to the non-standardization of their nomenclature, inadequate labelling of products containing PEGs, and the lack of suspicion as the agents responsible of such reactions. Skin prick tests have been used to rule in PEG sensitivity (See: Immediate allergic reactions by polyethylene glycol 4000: two cases). Pizzimenti S, Heffler E, Gentilcore E, Raie A, Bussolino C, Nebiolo F, et al. This site needs JavaScript to work properly. An allergological study was carried out with her prior consent. Although generally considered biologically inert, cases of mild to life-threatening immediate-type PEG hypersensitivity are reported with increasing frequency. Tracy Prematta MD. Stone CA Jr, Liu Y, Relling MV, et al. 3. Sección de Alergología, Hospital General Universitario de Elda, Ctra. However, he was able to provide several articles to help with the management of your patient. Allergy to polyethylene glycol should be considered in painters who develop urticarial or other systemic symptoms after handling these industrial products containing polyethylene glycol. Polyethylene glycol; electrolytes solution is contraindicated for use in those with known polyethylene glycol hypersensitivity or with hypersensitivity to any of … Allergy. Immediate-type hypersensitivity to polyethylene glycols: a review. Although generally considered biologically inert, cases of mild to life‐threatening immediate‐type PEG hypersensitivity are reported with increasing frequency. It is also recommended studying PEG allergy in reactions to products containing PEGs, once allergy to the active ingredients has been excluded and in reactions to multiple unrelated drugs. In the present case hypersensitivity to the additive polyethylene glycol was confirmed by an IDT suggesting an Immunoglobulin E-dependent mechanism as a cause of the reaction. eCollection 2019. : 2 Respirology and Allergy Clinic, Pusan National University Yangsan Hospital, Yangsan, Korea. a hapten-carrier mechanism). I have two main points to share; (1) Test Your Patients. Prick test and specific IgE were positive for mites and cypress, but negative for other aeroallergens, latex, anisakis, and several foods. Thousands of medications contain either PEGs or structurally similar polysorbates. The patient was diagnosed with immediate hypersensitivity IgE-mediated to PEG and its derivatives of different molecular weights contained in pharmacological and cosmetic products, with severe anaphylaxis to cough syrup (containing PEG 6000), moderate anaphylaxis to a skin antiseptic (containing PEG-9), contact urticaria or generalized urticaria to moisturizing skin creams (PEG-75 and PEG-100, respectively), contact angioedema by toothpaste (PEG-6), and subclinical skin and in vitro (BAT) sensitivity to poloxamer 407 and polysorbate 80. Contact Dermat. Summary Polyethylene glycols (PEGs) or macrogols are polyether compounds widely used in medical and household products. An 8-year-old girl and a 2.5-year-old boy, both diagnosed as having acute lymphobl … Immediate hypersensitivity to PEG 3350 with cross-reactive polysorbate 80 hypersensitivity may be under recognized in clinical practice and can be detected with clinical . 1). Polyethylene glycols (PEGs) or macrogols are polyether compounds and are widely used as additives in pharmaceuticals, cosmetics, and food. Oyarzabal NA, Areso NL, Belar NB, Popolizio IG, Arregui AV, de Vallejo OVB. Polyethylene glycols (PEGs) or macrogols are polyether compounds widely used in medical and household products. 2006;61(8):1021. doi: 10.1111/j.1398-9995.2006.01083.x. Levels of C3, C4, IgA, IgG, IgM, and tryptase were all within normal range. We present the case of a 29-years-old woman who developed several local and systemic type I hypersensitivity reactions including a severe anaphylactic reaction to different pharmacologic and cosmetic products whose excipients included PEG. Cookies policy. J Invest Dermatol. All the authors analyzed and discuss the results. Anaphylaxis; Drug additives; Hypersensitivity; Macrogol; Polyethylene glycol. Clin Exp Allergy. Non-specific activation was ruled out by testing healthy volunteers. OTC labeling: When used for self-medication, do not use if you have renal disease unless advised by a health care provider. -. BackgroundPolyethylene glycols (PEGs) and their derivatives are non-ionic polymers of ethylene oxide commercially available with numerous synonyms, such as macrogol, oxyethylene polymer, and laureth-9. 1 Coronavirus: Find the latest articles and preprints Standardization of the terminology used to describe the presence of PEGs in products would help patients to identify them clearly and unequivocally and thus avoid the development of hypersensitivity reactions. 2021 Feb;9(2):670-675. doi: 10.1016/j.jaip.2020.09.029. This study showed that a single i.v. The mechanisms by which PEG causes anaphylaxis is known (See: Polyethylene Glycol Is a Cause of IgE-Mediated Anaphylaxis). Turner PJ, Ansotegui IJ, Campbell DE, Cardona V, Ebisawa M, El-Gamal Y, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Leung ASY, Levin ME, Muraro A, Sánchez Borges M, Senna G, Tanno LK, Yu-Hor Thong B, Worm M; WAO Anaphylaxis Committee. Although IgG antibodies against both preparations of asparaginase have been detected and In our case we demonstrated an immediate hypersensitivity IgE-mediated to PEG by positive skin prick test and positive BAT. Unable to load your collection due to an error, Unable to load your delegates due to an error. Clinical study protocol number PI2018/29 (registered on 24 September 2018). Immediate-type hypersensitivity to polyethylene glycols: a review. Fruijtier-Polloth C. Safety assessment on polyethylene glycols (PEGs) and their derivatives as used in cosmetic products. In August, CHD asked regulators to investigate the use of polyethylene glycol (PEG) in COVID mRNA vaccines, which could have caused the severe allergic reactions reported this week by two of the first UK recipients of Pfizer’s vaccine. Thousands of medications contain either PEGs or structurally similar polysorbates. I have two main points to share; (1) Test Your Patients. Vicente Jover Cerdá. Au EYL, Rosa Duque JS, Lau CS, Chan E. A patient with anaphylaxis to diphenhydramine without cross-reactivity to loratadine. Department of Pediatrics, The Pennsylvania State University College of Medicine, PA, USA. PEG-derivatives also resulted positive in the prick test. One of such cases developed anaphylaxis to diphenhydramine included in the intranasal drops Coldistan® [6]. Allergy, Asthma & Clinical Immunology Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 2016. Although generally considered biologically inert, cases of mild to life-threatening immediate-type PEG hypersensitivity are reported with increasing frequency. Polyethylene glycol is an ingredient in many laxatives, in about 30% of tablets and is used as a surfactant in many injectable formulations, where a prolonged effect is needed, such as in depot steroids. J Allergy Clin Immunol Pract. Google Scholar. Basophil activation test results (right): Q2-1 represents activated basophils CD63+IgE+ (% indicated) and Q4-1 represents non-activated basophils CD63−IgE+. eCollection 2021. Skin prick tests have been used to rule in PEG sensitivity (See: Immediate allergic reactions by polyethylene glycol 4000: two cases). Background: 2018;78(3):211–5. Nevertheless, the term “PEG” is often used in combination with a number referring to the number of ethylene oxide units (cosmetic industry) or to the molecular weight (pharmaceutical industry) [2]. We also performed a basophil activation test (BAT) to the products listed in Table 1. Keywords: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Although generally considered biologically inert, cases of mild to life-threatening immediate-type PEG hypersensitivity are reported with increasing frequency. IgE test was negative, but we cannot rule out a potential reaction in vivo. Anaphylactic shock due to allergy to macrogol 4000 contained in SonoVue®. Anaphylaxis with PEG-ASP is rare. Polyethylene glycols (PEGs) or macrogols are polyether compounds widely used in medical and household products.

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